Getting by on $5 an hour

Five days a week, Phyllis Brooks goes to the apartment with the cream-colored walls and the brown-flowered sofa to care for her client, Syveria McLean.

She helps McLean, who is 70 and has epilepsy, with her bath. She combs her wavy, gray hair and helps her dress. She makes her lunch and sometimes dinner. She tidies up the apartment, cleans the bathroom, washes the dishes and does McLean's laundry. Some days, she takes McLean to the beauty parlor or to her doctor's appointments.


"Everything that I ask her to do, she does for me, thank God," McLean said in her studio apartment last week.

But Brooks, technically a contract worker for the state as part of a program that provides Medicaid patients with personal care workers at home, barely earns enough money to get by herself, she says. Her pay is the equivalent of about $5 an hour - less than the federal minimum wage of $5.15 an hour and less than half of Baltimore's $10.50-an-hour living wage.


Brooks and other personal care workers who contract with the state - represented by the American Federation of State, County and Municipal Employees, or AFSCME - are lobbying for a pay raise. Squeezed between an underfunded Medicaid program and their minimal status as contract workers, the personal care workers say they haven't had a raise in 18 years.

The care workers are part of a Medicaid program created more than 20 years ago to give elderly and disabled people long-term care in their homes. Of about 3,000 workers in the program, a third work in Baltimore. Because the workers contract with the state, rather than being government employees, they do not receive worker's compensation, unemployment insurance, sick leave, paid vacations or health insurance, said Eleanor Mahoney, a research analyst at AFSCME.

In Maryland, Medicaid programs cost taxpayers close to $5 billion a year - almost $800 for every man, woman and child in the state - but not enough to support the program, Nelson J. Sabatini, secretary of the state Department of Health and Mental Hygiene, said Thursday.

"I am not about to defend the adequacy of the [personal care workers'] payments. They are embarrassingly low, and they haven't been raised in many years, that's all true," Sabatini said. "That's true of a number of parts of the Medicaid program."

Raises for the 3,000 personal care workers would have to be funded in the state budget for the 2006 fiscal year, through the Department of Health and Mental Hygiene. Sabatini declined to discuss his specific budget plans before submitting them to Gov. Robert L. Ehrlich Jr., something he said was a continuing process between now and January.

"What these people are saying is, 'We haven't had a raise in a long time. What we are being paid is abysmal and very low. What we do is very important,' " Sabatini said. "And I say, 'Yes, you're absolutely right.' But I don't have enough money to keep doing what I'm doing in the Medicaid program, and where do you get the money to pay for this?"

A spokesman for the governor declined to comment on the personal care workers' salaries, saying it was premature to discuss the issue before the governor reviews the health department's budget proposal.

"The governor is very sensitive to the needs of those who work for the state or with the state," the spokesman, Henry Fawell, said. "He proposed a 2 percent cost-of-living increase last year for state employees, so he's always been sensitive to their needs."


If the governor puts the raises in the state budget, the General Assembly would have to maintain that funding throughout the budget process.

"I'm very hopeful that he [Ehrlich] recognizes the role that they play in people's lives and moves ahead with the increase," said Del. Peter A. Hammen, a Baltimore Democrat who is vice chairman of the health and government operations committee. "I'm almost certain that the legislature wouldn't cut it should the governor put the money into his budget."

Baltimore state Sens. Verna L. Jones and Lisa A. Gladden, Baltimore Del. Salima S. Marriott and Prince George's County Del. Joanne C. Benson, all Democrats, voiced support for the workers at a town hall meeting Thursday at Baltimore's central Enoch Pratt Free Library.

The workers are paid a flat rate for their services: $10 for a visit with a client that requires minimal care, typically a two-hour visit; $20 for a client that needs a bit more care, usually about a four-hour visit; and $50 for a client that needs live-in help, or a 24-hour visit.

While personal care workers in general are often low-paid - the median wage for one in Maryland is $8.77 an hour, compared with $8.25 in Pennsylvania and $8.39 in Michigan - advocates say other Maryland workers with similar job duties make higher wages. Mahoney said training for personal care workers is not very extensive, typically a week of preparation from the state.

She said private-sector personal-care workers earn about $15 an hour, while home care workers in other Medicaid programs earn between $9 an hour and $11 an hour.


Higher wages and better training and benefits for personal care workers would decrease turnover and provide a more stable work force for a program that saves the state money by keeping Maryland residents out of nursing homes, the workers' advocates said.

"In many instances, it does wind up being less expensive to provide some services to keep people in their own homes than it does to cover the cost of nursing homes," said Steven Edelstein, national policy director at the Paraprofessional Healthcare Institute, a nonprofit agency in New York that seeks to strengthen the nation's direct-care work force.

In Maryland, workers in the Medicaid personal care program - including Brooks, who is 64 and has been working with the program for 23 years - said they have to take second jobs to make ends meet.

For about $5 an hour, Brooks works 40 hours per week through the Medicaid program and spends another 10 hours a week with a private client. A single woman, she said she relies on financial help from friends and family to make her $440 monthly rent payment and buy her bus pass for $64 a month.

Patrice Robinson, who has been a personal care worker for 18 years, works as a hotel housekeeper on the side to keep up with her bills. Her clients, like Betty Steed-Jones, 77, who has diabetes and other ailments, have come to rely on Robinson.

When Steed-Jones, a widow who lives alone, doesn't want to get out of bed in the mornings, it is Robinson who coaxes her out. Steed-Jones said Robinson keeps her company, talks to her and gets her going in the mornings - in addition to her regular job duties.


"She has not only been a caretaker," Steed-Jones said. "She's been everything to me."